Two Cases with Use of Free Flap Transfer and Titanium Mesh Plate for Craniofacial Reconstruction with More than 8 Years of Follow-up

Abstract

We report two cases of free flap transfer combined with titanium mesh plate for craniofacial reconstruction. The flaps drooped and thinned over more than 8 years of follow-up.
In one case, the titanium mesh plate was exposed from the top of the latissimus dorsi M-C flap. Gravity may affect thinning of the flap. The edges of the titanium mesh led to breakdown of thin portions of the flap. Fortunately, the titanium mesh prevented abscess spreading under the mesh plate. There was no need for total removal of the titanium mesh plate, and only the exposed side was cut followed by coverage with a local flap.
In the other case, the titanium plate was not exposed from the forearm flap. This case was treated with palmaris longus tendon grafting between the flap and the titanium mesh plate. This tendon prevented drooping of the forearm flap and exposure of the titanium mesh.
Smooth margins of the titanium mesh plate and flap suspension, and coverage of the titanium edges by free tendon graft may be effective in preventing exposure of the titanium mesh plate in craniofacial reconstruction for the long term.